DRUGS of ABUSE / Uses and Effects
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Anaesthesia and Past Use Of
177 Correspondence were using LSD. It is more popular than other commonly Anaesthesia and past use of used hallucinogens whose quoted incidence of clients are: LSD ketamine 0.1% (super-K/vitamin K.I), psilocybin and psilocin 0.6% (the active alkaloids in the Mexican "magic To the Editor: mushroom"), and 3,4 methylenedioxymethamphetamine We report the case of a 43-yr-old lady who was admitted ~MDMA" 1% (ecstasy). The effects of the concurrent to the Day Surgery Unit for release of her carpal tunnel ingestion of LSD on anaesthesia are well described. 2-4 retinaculum. During the preoperative visit, she reported The long-term effects of the past use of LSD are largely no intercurrent illnesses, drug therapy or allergies. She unknown. We wonder if the hallucinations experienced did say, however, that she was frightened of general anaes- by our patient during anaesthesia were due to her LSD thesia, since she had experienced terrifying dreams during intake many years before. We would be interested to surgery under general anaesthesia on three occasions dur- know if others have had experience anaesthetising patients ing the previous ten years. On further questioning, she who are past users of phencyclidine-derived drugs. admitted that she had used lysergic acid diethylamide (LSD) during the late 1960's, the last occasion being 1968 Geoffrey N. Morris MRCGPFRCA when she had experienced characterstic hallucinations. Patrick T. Magee MSe FRCA She had not experienced hallucinations in the ensuing Anaesthetic Department years, except on the surgical occasions mentioned. Royal United Hospital One of the three previous operations had been per- Combe Park formed at our hospital and the anaesthetic record was Bath BA1 3NG checked. -
Guidelines for the Forensic Analysis of Drugs Facilitating Sexual Assault and Other Criminal Acts
Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel.: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org Guidelines for the Forensic analysis of drugs facilitating sexual assault and other criminal acts United Nations publication Printed in Austria ST/NAR/45 *1186331*V.11-86331—December 2011 —300 Photo credits: UNODC Photo Library, iStock.com/Abel Mitja Varela Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts UNITED NATIONS New York, 2011 ST/NAR/45 © United Nations, December 2011. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. List of abbreviations . v Acknowledgements .......................................... vii 1. Introduction............................................. 1 1.1. Background ........................................ 1 1.2. Purpose and scope of the manual ...................... 2 2. Investigative and analytical challenges ....................... 5 3 Evidence collection ...................................... 9 3.1. Evidence collection kits .............................. 9 3.2. Sample transfer and storage........................... 10 3.3. Biological samples and sampling ...................... 11 3.4. Other samples ...................................... 12 4. Analytical considerations .................................. 13 4.1. Substances encountered in DFSA and other DFC cases .... 13 4.2. Procedures and analytical strategy...................... 14 4.3. Analytical methodology .............................. 15 4.4. -
Evidence for the Involvement of Spinal Cord 1 Adrenoceptors in Nitrous
Anesthesiology 2002; 97:1458–65 © 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Evidence for the Involvement of Spinal Cord ␣ 1 Adrenoceptors in Nitrous Oxide–induced Antinociceptive Effects in Fischer Rats Ryo Orii, M.D., D.M.Sc.,* Yoko Ohashi, M.D.,* Tianzhi Guo, M.D.,† Laura E. Nelson, B.A.,‡ Toshikazu Hashimoto, M.D.,* Mervyn Maze, M.B., Ch.B.,§ Masahiko Fujinaga, M.D.ʈ Background: In a previous study, the authors found that ni- opioid peptide release in the brain stem, leading to the trous oxide (N O) exposure induces c-Fos (an immunohisto- 2 activation of the descending noradrenergic inhibitory chemical marker of neuronal activation) in spinal cord ␥-ami- nobutyric acid–mediated (GABAergic) neurons in Fischer rats. neurons, which results in modulation of the pain–noci- 1 In this study, the authors sought evidence for the involvement ceptive processing in the spinal cord. Available evi- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/97/6/1458/337059/0000542-200212000-00018.pdf by guest on 01 October 2021 ␣ of 1 adrenoceptors in the antinociceptive effect of N2O and in dence suggests that at the level of the spinal cord, there activation of GABAergic neurons in the spinal cord. appear to be at least two neuronal systems that are Methods: Adult male Fischer rats were injected intraperitone- involved (fig. 1). In one of the pathways, activation of ally with ␣ adrenoceptor antagonist, ␣ adrenoceptor antago- 1 2 ␣ nist, opioid receptor antagonist, or serotonin receptor antago- the 2 adrenoceptors produces either direct presynaptic nist and, 15 min later, were exposed to either air (control) or inhibition of neurotransmitter release from primary af- 75% N2O. -
(12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 De Juan Et Al
US 200601 10428A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 de Juan et al. (43) Pub. Date: May 25, 2006 (54) METHODS AND DEVICES FOR THE Publication Classification TREATMENT OF OCULAR CONDITIONS (51) Int. Cl. (76) Inventors: Eugene de Juan, LaCanada, CA (US); A6F 2/00 (2006.01) Signe E. Varner, Los Angeles, CA (52) U.S. Cl. .............................................................. 424/427 (US); Laurie R. Lawin, New Brighton, MN (US) (57) ABSTRACT Correspondence Address: Featured is a method for instilling one or more bioactive SCOTT PRIBNOW agents into ocular tissue within an eye of a patient for the Kagan Binder, PLLC treatment of an ocular condition, the method comprising Suite 200 concurrently using at least two of the following bioactive 221 Main Street North agent delivery methods (A)-(C): Stillwater, MN 55082 (US) (A) implanting a Sustained release delivery device com (21) Appl. No.: 11/175,850 prising one or more bioactive agents in a posterior region of the eye so that it delivers the one or more (22) Filed: Jul. 5, 2005 bioactive agents into the vitreous humor of the eye; (B) instilling (e.g., injecting or implanting) one or more Related U.S. Application Data bioactive agents Subretinally; and (60) Provisional application No. 60/585,236, filed on Jul. (C) instilling (e.g., injecting or delivering by ocular ion 2, 2004. Provisional application No. 60/669,701, filed tophoresis) one or more bioactive agents into the Vit on Apr. 8, 2005. reous humor of the eye. Patent Application Publication May 25, 2006 Sheet 1 of 22 US 2006/0110428A1 R 2 2 C.6 Fig. -
5-HT2A and 5-HT2C/2B Receptor Subtypes Modulate
5-HT2A and 5-HT2C/2B Receptor Subtypes Modulate Dopamine Release Induced in Vivo by Amphetamine and Morphine in Both the Rat Nucleus Accumbens and Striatum Grégory Porras, M.S., Vincenzo Di Matteo, Ph.D., Claudia Fracasso, B.S., Guillaume Lucas, Ph.D., Philippe De Deurwaerdère, Ph.D., Silvio Caccia, Ph.D., Ennio Esposito, M.D., Ph.D., and Umberto Spampinato, M.D., Ph.D. In vivo microdialysis and single-cell extracellular neuron firing rate in both the ventral tegmental area and recordings were used to assess the involvement of the substantia nigra pars compacta was unaffected by SR serotonin2A (5-HT2A) and serotonin2C/2B (5-HT2C/2B) 46349B (0.1 mg/kg i.v.) but significantly potentiated by SB receptors in the effects induced by amphetamine and 206553 (0.1 mg/kg i.v.). These results show that 5-HT2A morphine on dopaminergic (DA) activity within the and 5-HT2C receptors regulate specifically the activation of mesoaccumbal and nigrostriatal pathways. The increase in midbrain DA neurons induced by amphetamine and DA release induced by amphetamine (2 mg/kg i.p.) in the morphine, respectively. This differential contribution may nucleus accumbens and striatum was significantly reduced be related to the specific mechanism of action of the drug by the selective 5-HT2A antagonist SR 46349B (0.5 mg/kg considered and to the neuronal circuitry involved in their s.c.), but not affected by the 5-HT2C/2B antagonist SB effect on DA neurons. Furthermore, these results suggest 206553 (5 mg/kg i.p.). In contrast, the enhancement of that 5-HT2C receptors selectively modulate the impulse accumbal and striatal DA output induced by morphine (2.5 flow–dependent release of DA. -
HIV and Substance Use October 2016
HIV and Substance Use October 2016 Fast Facts • Alcohol and other drugs can affect a person’s judgment and increase risk of getting or transmitting HIV. • In people living with HIV, substance use can worsen the overall consequences of HIV. • Social and structural factors make it difficult to prevent HIV among people who use substances. Substance use disorders, which are problematic patterns of using alcohol or another substance, such as crack cocaine, methamphetamine (“meth”), amyl nitrite (“poppers”), prescription opioids, and heroin, are closely associated with HIV and other sexually transmitted diseases. Injection drug use (IDU) can be a direct route of HIV transmission if people share needles, syringes, or other injection materials that are contaminated with HIV. However, drinking alcohol and ingesting, smoking, or inhaling drugs are also associated with increased risk for HIV. These substances alter judgment, which can lead to risky sexual behaviors (e.g., having sex without a condom, having multiple partners) that can make people more likely to get and transmit HIV. In people living with HIV, substance use can hasten disease progression, affect adherence to antiretroviral therapy (HIV medicine), and worsen the overall consequences of HIV. Commonly Used Substances and HIV Risk • Alcohol. Excessive alcohol consumption, notably binge drinking, can be an important risk factor for HIV because it is linked to risky sexual behaviors and, among people living with HIV, can hurt treatment outcomes. • Opioids. Opioids, a class of drugs that reduce pain, include both prescription drugs and heroin. They are associated with HIV risk behaviors such as needle sharing when injected and risky sex, and have been linked to a recent HIV outbreak. -
List of Union Reference Dates A
Active substance name (INN) EU DLP BfArM / BAH DLP yearly PSUR 6-month-PSUR yearly PSUR bis DLP (List of Union PSUR Submission Reference Dates and Frequency (List of Union Frequency of Reference Dates and submission of Periodic Frequency of submission of Safety Update Reports, Periodic Safety Update 30 Nov. 2012) Reports, 30 Nov. -
211230Orig1s000 211230Orig2s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 211230Orig1s000 211230Orig2s000 RISK ASSESSMENT and RISK MITIGATION REVIEW(S) Division of Risk Management (DRISK) Office of Medication Error Prevention and Risk Management (OMEPRM) Office of Surveillance and Epidemiology (OSE) Center for Drug Evaluation and Research (CDER) Application Type NDA Application Number 211230 PDUFA Goal Date December 20, 2018 OSE RCM # 2018‐1313 Reviewer Name(s) Naomi Redd, Pharm.D. Team Leader Elizabeth Everhart, RN, MSN, ACNP Division Director Cynthia LaCivita, Pharm.D. Review Completion Date September 25, 2018 Subject Evaluation of the Need for a REMS Established Name Solriamfetol Trade Name Sunosi Name of Applicant Jazz Pharmaceuticals Therapeutic class Dopamine and Norepinephrine Reuptake Inhibitor (DNRI) Formulation 75 mg, 150 mg (b) (4) oral tablets Dosing Regimen Take one tablet once daily upon awakening 1 Reference ID: 4327439 Table of Contents EXECUTIVE SUMMARY ......................................................................................................................................................... 3 1 Introduction ..................................................................................................................................................................... 3 2 Background ...................................................................................................................................................................... 3 2.1 Product Information .......................................................................................................................................... -
Neurological Complications of Nitrous Oxide Abuse
Katherine Shoults, MD Case report: Neurological complications of nitrous oxide abuse A patient who presented with limb paresthesia and B12 deficiency was eventually diagnosed with subacute combined degeneration neuropathy secondary to nitrous oxide abuse. Case data ABSTRACT: A 34-year-old female ary to nitrous oxide (“laughing gas”) A 34-year-old female presented with with a history of alcohol and crystal abuse that had affected B12 activa- a 2-week history of progressive bilat- methamphetamine abuse presented tion. The patient was continued on eral limb paresthesia and tenderness, to the emergency department with B12 therapy, neurology follow-up as well as an inability to balance. She limb paresthesia and difficulty walk- was arranged, and addiction coun- had been well previously, although ing. At a primary care visit a week seling services were recommended. she did have a history of alcohol and earlier her progressive neurological Unfortunately, the patient was lost crystal methamphetamine abuse. She compromise had been viewed in the to follow-up after discharge from the had abstained from crystal metham- context of anemia and she was start- hospital. Physicians should be aware phetamine for 5 years and from alco- ed on daily B12 injections. Further that nitrous oxide is easy to acquire hol for 2 months. She was working as a investigations in hospital revealed in the form of commercially available care aid and denied using illegal drugs diminished proprioception, hyperal- cartridges or whipped cream canis- currently, but reported she had been gesia with pinprick and temperature ters called “whippits” and abuse of inhaling nitrous oxide (“laughing tests, a wide-based high-steppage nitrous oxide is increasingly com- gas”) for 6 months, with an escalation gait, elevated levels of B12 and ho- mon. -
Misuse of Drugs Act 1975
Reprint as at 1 July 2014 Misuse of Drugs Act 1975 Public Act 1975 No 116 Date of assent 10 October 1975 Commencement see section 1(2) Contents Page Title 4 1 Short Title and commencement 4 2 Interpretation 4 3 Act to bind the Crown 9 3A Classification of drugs 9 4 Amendment of schedules that identify controlled drugs 10 and precursor substances, and set amount, level, or quantity at and over which controlled drugs are presumed to be for supply 4A Procedure for bringing Order in Council made under 12 section 4(1) or (1B) into force 4B Matters to which Minister must have regard before 13 recommending Order in Council under section 4(1) or (1B) 4C Temporary class drug notice [Repealed] 14 4D Effect of temporary class drug notice [Repealed] 15 4E Duration of temporary class drug notice [Repealed] 15 Note Changes authorised by subpart 2 of Part 2 of the Legislation Act 2012 have been made in this official reprint. Note 4 at the end of this reprint provides a list of the amendments incorporated. This Act is administered by the Ministry of Health. 1 Reprinted as at Misuse of Drugs Act 1975 1 July 2014 5 Advisory and technical committees 15 5AA Expert Advisory Committee on Drugs 15 5A Approved laboratories 17 5B Functions of Minister 17 6 Dealing with controlled drugs 18 7 Possession and use of controlled drugs 20 8 Exemptions from sections 6 and 7 22 9 Cultivation of prohibited plants 26 10 Aiding offences against corresponding law of another 27 country 11 Theft, etc, of controlled drugs 28 12 Use of premises or vehicle, etc 29 12A Equipment, -
Forensic Toxicology Laboratory Office of Chief Medical Examiner City of New York
FORENSIC TOXICOLOGY LABORATORY OFFICE OF CHIEF MEDICAL EXAMINER CITY OF NEW YORK CARISOPRODOL , MEPROBAMATE and TOPIRAMATE by SOLID PHASE EXTRACTION and GAS CHROMATOGRAPHY/MASS SPECTROMETRY (Selected Ion Monitoring) PRINCIPLE Carisoprodol is a carbamate derivative first synthesized in 1959. It is primarily used as a muscle relaxant. UncontrolledMeprobamate is also a carbamate derivative used as a muscle relaxant and the primary metabolite of carisoprodol. Topiramate is a sulfamate-substituted monosaccharide used as an anticonvulsant Carisoprodol, meprobamate and topiramate are quantitated by a selected ion monitoring (SIM) method using methapyrilene as the internal standard. Carisoprodol, meprobamate and topiramate are extracted from biological specimens by solid phase extraction. Drugs are temporarily bound to a sorbent in the solid phase cartridge as the prepared sample is poured through the column. The column is washed to remove interfering compounds, followed by elution of drugs from the column. The eluate is evaporated, reconstituted and injected in the GCMS. Quantitative analysis is performed by SIM GCMS using a six point calibration curve. SAFETY The handling of all biological specimens and reagents is performed within the guidelines which are detailed in the Safety and Health manual. Copy SPECIMEN PREPARATION The procedure is routinely applied to the following biological specimens and their aliquots unless otherwise specified: Blood 0.5 mL of the undiluted specimen Urine 0.5 mL for qualitative identification Brain 0.5 mL of a 1:3 homogenate Gastric Contents 0.5 mL of a 1:10 dilution Liver 0.5 mL of a 1:5 homogenate Vitreous Humor 0.5 mL of the undiluted specimen Bile 0.5 mL of the undiluted specimen Reviewed by: Date: Page 1 of 14 T:\FINALSOP\FINAL SOP PDF\G. -
Lidocaine Infusion for Analgesia MOA Pharmacology 1
Lidocaine Infusion for Analgesia MOA Pharmacology 1. Attenuation of proinflammatory effects: Ø Hepatic metabolism with high extraction ratio; Ø Blocks polymorphonuclear granulocyte priming, plasma clearance is 10 ml/kg/min13 reducing release of cytokines & reactive oxygen species1 Ø Adjust dose based on hepatic function and 2. Diminish nociceptive signaling to central nervous system: blood flow Ø Inhibition of G-protein-mediated effects2 Ø Renal clearance of metabolites Ø Reduces sensitivity & activity of spinal cord neurons Ø Context-sensitive half-time after a 3-day infusion is (glycine and NMDA receptor mediated)3,4 ∼20–40 min Ø Clinical effect of lidocaine tends to exceed the 5 3. Reduces ectopic activity of injured afferent nerves duration of the infusion by 5.5 times the half-life, supporting the putative preventive analgesia effect14 Perioperative Use Dosing Ø IV local anesthetic infusions have been used safely for pain control in the perioperative setting since the early 1950’s6,7 Infusion: 2mg/kg/hr (range 1.5-3 mg/kg/hr) Ø Reduce pain, nausea, ileus duration, opioid requirement, Loading dose: 1.5mg/kg (range 1-2 mg/kg) and length of hospital stay Ø Strongly consider bolus to rapidly achieve therapeutic concentration, otherwise steady state 9-12 Evidence for Specific Surgeries: reached in 4-8 hr Ø Strong: Open & laparoscopic abdominal; Reduces Max dose: 4.5 mg/kg postoperative pain, speeds return of bowel function, Ø Consider total dose from other local anesthetics reduces PONV, reduces length of hospital stay (e.g. regional anesthesia, periarticular injections, & Ø Moderate: Open prostatectomy, thoracic procedures, local infiltration) ambulatory surgery, and major spine; Reduces Continuous infusions up to 3 mg/kg/hr have been postoperative pain and opioid consumption shown to be safe Ø Moderate: Breast; Prevention of chronic postsurgical pain Ø Reduce infusion rate in patients with impaired Ø No benefit: Total abdominal hysterectomy, total hip drug metabolism & clearance (i.e.